Annie Williams MLHD Manager of Innovation & Redesign

Palliative Patient Journeys

Providing Services in a Regional and Rural Setting

Palliative Care Service Delivery in MLHD

NSW Health Palliative Care Services Plan

NSW Palliative Care Strategic Framework

MLHD Palliative Care Clinical Services Plan

How are we delivering Palliative

Care Services now?

Western eastern

Primary

Enhanced

Level 1: Specialist.

 

MLHD Palliative Care Model

Objective:

To provide a current state business process and patient journey analysis of the MLHD Palliative Care Patients whom access services within Griffith and the surrounding region

Scope: Documentation of current palliative patient flow, operational activities

and business processes centred on Griffith, and local communities

Processes from Patient referral to EOL care

160 KM

65KM

110 KM

90 KM

140

KM

60 KM

Geographical Implications:

Project Methodology:

Patient and Carer Interviews: De-identified interviews conducted with palliative patients, and/or carers whom have referred to or accessed the services of the Palliative Care Service.

Process Mapping:

Patient Flow - Data Analysis Outreach Sites:

PC Team Roster & Service Model Changes

MLHD: GRIFFITH CH PALLIATIVE CARE SERVICE ACTIVITY

OCCASIONS OF SERVICE – IN HOURS AND AFTER HOURS

Patient Flow - Data Analysis Griffith:

Admissions28 % decrease 

 

Patient Flow – Community to Acute Care:

MLHD: PALLIATIVE CARE Multiple Admissions & Readmissions to Griffith Base Hospital

71 %

decrease

Patient Flow – Readmissions to Acute Care:

A decrease in the number of acute Palliative Care admissions

A consistent length of stay for Palliative Care patients [median 4 days from 2012 to 2015]

A significant drop in Palliative Care patients whom are admitted to the acute service on more than one occasion

Early identification of patients

A proactive approach to resourcing and delivery of supported palliative care in patients homes,  

Provision of after hours services to unstable patients only as required

Building of enhanced relationships with outreach sites

Patient Flow – Key Findings:

Quantification of Patient Experience Patient and carer perceptions of the healthcare journey comprise the “Patient Experience”. Research from the NHS & Picker Institute provides key themes valued by both patients and carers:

Access to Care

Respect for Patient values, preferences, and expressed needs

Coordination and integration of care

Information and education

Transition and continuity

Physical comfort

Emotional support and alleviation of fear and anxiety

Involvement of family and friends

What our patients and carers told us:

Early on, it was necessary for Lois to have a syringe

driver, so that it could help to manage her pain. This worked as a partnership between myself and the

Palliative Care Nurse; we worked really well

together.

I think that this is a great idea to investigate how to

do longer term patient surveys and to talk about our experiences – it is the

only way that we can improve the services to our

communities and acknowledge the great

services we have!We wish we knew about it sooner!

… things were deteriorating;

they were there whenever we needed them.

…my GP who I knew very well and was caring for me well, does not have admitting rights to the hospital, so each time I went in, there was a process of transferring my case over to another doctor,

I had only ever heard about Palliative Care in relation to cancer care, I didn’t realise that they could support Charley in the end stages of his illness

I was told by the nurse to “get dressed you are going home”. ..no one had told me of any plans

Palliative Patient Journey – Acute Palliative Care Services

Palliative Patient Journey – Community Palliative Care Services

Quantification of Patient Experience

Patient Journey Impacts

GP PCT

HOME

AHED

ACUTE

D/C